The bladder (detrusor) is a muscular reservoir that remains floppy and relaxed while it fills with urine.
A ring of muscle (the sphincter) sits at the bladder outlet (the urethra) and squeezes shut while the bladder fills, stopping urine from leaking.
When the brain gives the command to pass urine, the bladder muscle squeezes and the sphincter relaxes. This allows the bladder to push out the urine through an open passageway.
After the urine is emptied from the bladder, the bladder relaxes again and the sphincter tightens and closes.
This sequence of events is in reality a coordinated and complex interaction between nerves and muscles at many levels in the body. Many disease processes can cause a disruption in the normal bladder function and lead to leakage of urine, difficulty emptying urine or even a combination of both.
Urinary incontinence is the involuntary leakage of urine. This is a common condition experienced by men and women of all ages. It is often a treatable condition and not something that a person just has to put up with. Unfortunately patients often delay seeking treatment which could improve their quality of life.
Stress incontinence is leakage that occurs with physical activity or an increase in abdominal (belly) pressure. The cause is a weak sphincter that is unable to close tightly enough to keep the urine in the bladder during these activities.
People may experience leakage with coughing, laughing, sneezing, lifting, straining or even simply getting out of a chair or bending over.
Stress urinary incontinence is an extremely common problem and can occur in women after childbirth or vaginal surgery and in men after prostate surgery. It can also occur in both sexes without any triggering factor as a consequence of ageing.
Also referred to as “overactive bladder” this type of incontinence is usually accompanied by a sudden, strong urge to pass urine and an inability to get to the toilet fast enough. Some patients with urgency incontinence may leak urine with no warning.
This type of incontinence is caused by a bladder muscle that squeezes before the bladder is full, or the command is given to pass urine.
Things that make urgency incontinence more likely include aging, obstruction of urine flow (from an enlarged prostate for example), inconsistent emptying of the bladder and a diet high in bladder irritants (such as coffee, tea, colas, chocolate and acidic fruit juices).
Mixed incontinence is a combination of urgency and stress incontinence.
Overflow incontinence occurs when the bladder does not empty properly and the amount of urine produced exceeds the capacity of the bladder.
It can cause frequent urination and dribbling. Poor bladder emptying occurs if there is an obstruction to flow or if the bladder muscle cannot contract effectively.
This is a very important step, as different types of incontinence need different types of therapy, ranging from behavioral changes to surgery.
To accurately diagnose your urinary incontinence your doctor will take a careful history, focusing on the factors that cause your leakage and the events surrounding it.
They need to consider your holistic wellbeing and take into account your other medical conditions as well as your social situation and toileting behaviors.
Some tests including urodynamics may be necessary to further the accuracy of the diagnosis.
As mentioned previously, the therapy to treat your urinary incontinence needs to be tailored to your unique situation. Behavioral changes will be discussed, including modifications to diet, lifestyle and toileting habits.
Medical and surgical options are available which have excellent success rates in treating incontinence. These are reserved for patients who do not respond to non surgical therapies.
The surgeons at Perth Urology Clinic specialise in urodynamic evaluation and can diagnose and make a plan for your incontinence. They specialise in overactive bladder management and can discuss all medical and surgical options for this including Botox to the bladder and neuromodulation.
Incontinence of urine is a treatable condition and not something that you just have to live with!